Provider Demographics
NPI:1619911518
Name:NIBLER, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:NIBLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:216 3RD ST W
Mailing Address - Street 2:STE 201
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1602
Mailing Address - Country:US
Mailing Address - Phone:715-685-0656
Mailing Address - Fax:715-685-9326
Practice Address - Street 1:216 3RD ST W
Practice Address - Street 2:STE 201
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1602
Practice Address - Country:US
Practice Address - Phone:715-685-0656
Practice Address - Fax:715-685-9326
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI16136208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30973000Medicaid
WIP00063977OtherRAILROAD MEDICARE
WI000204025Medicare PIN
B85113Medicare UPIN